Results of Ovarian Sparing Surgery in Pediatric Patients: Is There a Place for Laparoscopy?

Laparoscopy is widely accepted for the surgical treatment of benign ovarian lesions in adult women, with results similar to an open approach when spillage is avoided by different means such as endobag retrieval. This approach is controversial in children. Retrospective study (2009-2018) of all pediatric ovarian tumors with histological confirmation treated in a tertiary center. Data regarding preoperative selection criteria, surgical technique, and follow-up were registered. Laparoscopy was used only in tumors without malignant features and whose size allowed retrieving them through a small incision without morcellating. Emphasis was set in ovarian sparing surgery (OSS), comparing the results of open (OP) and laparoscopic (LPC) approach. During the study period, 48 suspicious lesions in 45 patients were operated. Thirty cases (32 tumors) showed benign features (10 cystadenomas, 14 mature teratomas, 6 nontumor lesions); treatment consisted in oophorectomy in 13 (OP 6, LPC 7) and OSS in 17 (OP 5, LPC 12). There was one conversion in the LPC group. Mean follow-up was 3.44 years (range 0.03-8.84), based on annual ultrasound (US) and tumor markers during at least 5 years, recommending a lifetime follow-up by a gynecologist. There was only one relapse in a laparoscopically enucleated cystadenoma, and 2 patients developed contralateral metacronous teratomas. No procedure-related complications happened. Our series, although small and with a limited follow-up, suggest that laparoscopy could be an option of treatment in a subset of highly selected patients, although laparotomy remains the gold standard approach if malignancy is suspected.